Hepatic Granulomas: A Review With Emphasis on Infectious Causes

Abstract

Context Many diseases that cause granulomas or granulomatous inflammation involve the liver. Some of these disease processes are intrinsic hepatic diseases, whereas others are disseminated systemic diseases that involve the liver as well as other organs. Objective To review the evaluation of granulomas in the liver with an emphasis on infectious causes, as well as the use of special stains, serologic studies, and molecular diagnostic techniques. Pertinent noninfectious causes of hepatic granulomas that are in the differential diagnosis are also discussed. Data Sources Literature review and cases acquired during years of practice. Conclusions A wide variety of infectious and noninfectious entities cause hepatic granulomas.

Hepatic granulomas: a 17‐year single tertiary centre experience

“…On the basis of clinical presentation and the laboratory work‐up mentioned above, and in conjunction with the histological features, an attempt was made to assign every case to a specific aetiology. The diagnosis of hepatic tuberculosis was made in the presence of caseation necrosis or when alcohol‐acid resistant bacilli were seen or cultured . The diagnosis of sarcoidosis was suggested by the presence of non‐caseating granulomas without bacteria or fungi along with typical clinical presentation and results from laboratory work‐up .…”

Histopathology of granulomatous liver disease

“…Granulomas are relatively common in liver samples, identified in 2% to 10% of cases . Clinically, they may be restricted to the liver or reflect hepatic involvement by a systemic process.…”

“…The location and type of granuloma(s), background changes within the liver, and the presence or absence of systemic involvement help provide clues to the diagnosis. Clinical diseases associated with hepatic granulomas are listed in Table . The most common etiologies will be discussed briefly in the following sections.…”

“…A comprehensive review of infectious granulomas of the liver is beyond the scope of this article. Interested readers should see Lamps for a thorough and authoritative review.…”

Granulomas of the liver

“…Hepatic granulomas are localized collections of inflammatory cells, which are found in 2% to 10% of patients who undergo a liver biopsy . They can be associated with a variety of systemic conditions or may be an incidental finding on an otherwise normal liver biopsy.…”